American Speech-Language-Hearing Association

EBP Compendium: Summary of Systematic Review

Action Research
Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients

Ramsey, D. J., Smithard, D. G., et al. (2003).
Stroke, 34(5), 1252-1257.

Indicators of Review Quality:

The review addresses a clearly focused question No
Criteria for inclusion of studies are provided No
Search strategy is described in sufficient detail for replication Yes*
Included studies are assessed for study quality No
Quality assessments are reproducible No

Description: This is a review of studies investigating the early assessments of dysphagia and aspiration risk in acute stroke patients.

Question(s) Addressed:

Question not specifically stated.

Population: Acute stroke patients

Intervention/Assessment: Dysphagia assessments: bedside assessment of swallow, videofluoroscopy, pulse oximetry, fiberoptic endoscopy, and other methods.

Number of Studies Included: Not stated

Years Included: Not stated

Findings:

Conclusions:

  • Assessment/Diagnosis
    • Assessment Instruments
      • Swallowing
        • General Findings
          • The author concludes that all of the dysphagia assessments (e.g. bedside swallowing assessment, videoflouroscopy, FEES) have some strengths and limitations. Some assessments may be more useful when paired with other assessments.
          • Continued effort to improve the accuracy and repeatability of bedside swallow tests is recommended, as this assessment could be conducted by a range of professionals in a timely fashion to reduce the risk of malnutrition or aspiration.
          • Little evidence for clinical use was presented for these alternative assessments (e.g. cervical auscultation, radiographs, ultrasonography, manometry, scintigraphy, and electromyography).
        • Bedside Swallow Exam
          • The bedside swallowing assessment is the most frequently used dysphagia assessment. Sensitivity and specificity of this assessment range from 42% to 92% and 59% to 91%, respectively.
          • Continued effort to improve the accuracy and repeatability of bedside swallow tests is recommended, as this assessment could be conducted by a range of professionals in a timely fashion to reduce the risk of malnutrition or aspiration.
        • Fiberoptic Endoscopic Swallow Evaluation (FEES) - The sensitivity and specificity of fiberoptic endoscopy ranges from 65% to 100% and 39% to 96%, respectively.
        • Pulse Oximetry - Pulse oximetry is used to measure oxygen saturation which is reported to be reduced during times of aspiration. Sensitivity ranged from 73% to 87% and specificity ranged from 39% to 87%.
        • Videofluoroscopic Swallow Examination - Videofluoroscopy is often considered a gold standard of swallow testing. Several studies have noted that interjudge reliability is often variable.

Keywords: Stroke, Swallowing Disorders

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Note:

*A very brief statement regarding the search strategy is included. The databases searched and some keywords were provided, however no inclusion/exclusion criteria or search dates/years were provided.

Added to Compendium: December 2011

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